Maternal high-fat diet programs rat offspring hypertension and activates the adipose renin-angiotensin system.

OBJECTIVE: A maternal high-fat diet creates an increased risk of offspring obesity and systemic hypertension. Although the renal renin-angiotensin system (RAS) is known to regulate blood pressure, it is now recognized that the RAS is also activated in adipose tissue during obesity. We hypothesized that programmed offspring hypertension is associated with the activation of the adipose tissue RAS in the offspring of obese rat dams. STUDY DESIGN: At 3 weeks of age, female rats were weaned to a high-fat diet (60% k/cal; n = 6) or control diet (10% k/cal; n = 6). At 11 weeks of age, these rats were mated and continued on their respective diets during pregnancy. After birth, at 1 day of age, subcutaneous adipose tissue was collected; litter size was standardized, and pups were cross-fostered to either control or high-fat diet dams, which created 4 study groups. At 21 days of age, offspring were weaned to control or high-fat diet. At 6 months of age, body fat and blood pressure were measured. Thereafter, subcutaneous and retroperitoneal adipose tissue was harvested from male offspring. Protein expression of adipose tissue RAS components were determined by Western blotting. RESULTS: The maternal high-fat diet induced early and persistent alterations in offspring adipose RAS components. These changes were dependent on the period of exposure to the maternal high-fat diet, were adipose tissue specific (subcutaneous and retroperitoneal), and were exacerbated by a postnatal high-fat diet. Maternal high-fat diet increased adiposity and blood pressure in offspring, regardless of the period of exposure. CONCLUSION: These findings suggest that programmed adiposity and the activation of the adipose tissue RAS are associated with hypertension in offspring of obese dams.

A randomized comparison of oral mifepristone to intravenous oxytocin for labor induction in women with prelabor rupture of membranes beyond 36 weeks' gestation.

OBJECTIVE: This study was undertaken to compare the use of oral mifepristone with intravenous oxytocin for labor induction in women with prelabor rupture of membranes (PROM) at 36 weeks' or greater gestational age. STUDY DESIGN: Sixty-five women with spontaneous PROM were randomly assigned to receive orally administered mifepristone or oxytocin infusion. Two hundred milligrams of mifepristone was administered, and subjects were observed for 18 hours, or intravenous oxytocin was administered. RESULTS: Thirty-three women received mifepristone and 32 received oxytocin. The average interval from start of induction to delivery was 1194.1 +/- 568.7 minutes for mifepristone-treated subjects and 770.8 +/- 519.9 minutes for oxytocin-treated subjects ( P = .001, log-transformed data). Of 33 mifepristone-treated subjects and 32 oxytocin-treated subjects, 25 (78.1%) and 17 (51.5%), respectively, achieved successful induction (defined as vaginal delivery within 24 hours) (relative risk [RR] 0.66, 95% CI 0.45-0.96, P = .01). There was more fetal distress in the mifepristone-treated group (9 vs 2, RR 4.36, 95% CI 1.02-18.66, P = .02), and a trend toward more cesarean births (7 vs 3, RR 2.26, 95% CI 0.64-7.99, P = .19). Eleven infants of mifepristone-treated women (33.3%) and 3 infants of oxytocin-treated women (9.4%) were admitted to the neonatal intensive care unit (RR 3.56, 95% CI 1.09-11.58, P = .02). CONCLUSION: Oral mifepristone administration 18 hours before oxytocin infusion did not improve labor stimulation in women with PROM near term, and was associated with more adverse fetal outcomes.

A comparison of orally administered misoprostol to intravenous oxytocin for labor induction in women with favorable cervical examinations.

OBJECTIVE: The purpose of this study was to compare orally administered misoprostol with intravenous oxytocin infusion for labor induction in women with favorable cervical examinations (defined as a Bishop score of 6 or more). STUDY DESIGN: One hundred ninety-eight women with indications for labor induction and favorable cervical examinations were assigned randomly to receive oral misoprostol or oxytocin induction. Misoprostol, 100 mg, was administered every 4 hours up to 6 doses, or intravenous oxytocin was administered by standardized protocol. RESULTS: One hundred ten (55.6%) women received misoprostol; 88 (44.4%) received intravenous oxytocin. There was no statistically significant difference in the average interval from start of induction to vaginal delivery, being longer in the misoprostol group (789.4 +/- 510.2 minutes) than in the oxytocin group (654.0 +/- 338.2 minutes, P=.19, log-transformed data). Two women had tachysystole develop in each treatment group. More women in the misoprostol group experienced hyperstimulation (7/110, 6.4%) than in the oxytocin group (0/88, P=.02, Fisher exact test). Nine (8.1%) misoprostol-treated women and 8 (9.1%) oxytocin-treated women underwent cesarean deliveries (P=.82). There was a presumed uterine rupture in a misoprostol-treated multipara women. There were no statistically significant differences in neonatal outcomes between the groups. CONCLUSION: Oral misoprostol offers no benefit over intravenous oxytocin for labor induction in women with favorable cervical examinations. It is associated with a higher likelihood of uterine hyperstimulation and may increase the risk of uterine rupture.

Newly diagnosed adult-onset Still disease in pregnancy.

BACKGROUND: Adult-onset Still disease is a rare febrile disorder that can present for the first time during pregnancy. It is a diagnosis of exclusion with nonspecific laboratory results. Good maternal and fetal outcomes can be expected after initial diagnosis and treatment. CASE: A 21-year-old (gravida 2, para 1) at 20 weeks' gestation presented with fever, malaise, arthralgias, and cough. She had an extensive evaluation that led to the diagnosis of adult-onset Still disease. She was treated with prednisone and had immediate improvement. She delivered a viable infant at 34 weeks after suspected intrauterine growth restriction and continued to have recurrent symptoms postpartum. The second woman, 38 years old and gravida 3, para 1, aborta 1, presented at 22 weeks' gestation with similar symptoms and also had a similar diagnostic evaluation. She was diagnosed with adult-onset Still disease and started on prednisone, with immediate improvement, delivering a viable infant at 41 weeks' gestation. CONCLUSION: Adult-onset Still disease in pregnancy can be confused with many other diseases, but its diagnosis, after exclusion of other infectious, malignant, and rheumatic conditions, can portend good maternal and fetal outcomes.